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Interferon may help curb AIDS-related cryptococcal meningitis
  NEW YORK (Reuters Health) - Management of AIDS-related acute cryptococcal meningitis might be improved by the addition of recombinant interferon-gamma 1B to traditional antifungal protocols, researchers report in the June 15th issue of the Journal of Infectious Diseases.
Dr. Peter G. Pappas of the University of Alabama School of Medicine in Birmingham and colleagues conducted a double-blind, placebo-controlled study at 8 US sites and 2 sites in Peru.
Seventy-nine patients with AIDS and acute cryptococcal meningitis were randomized to receive either 100 g or 200 g of recombinant interferon-gamma 1b, or placebo, 3 times a week for 10 weeks. This was in addition to therapy with intravenous amphotericin with or without flucytosine, followed by treatment with fluconazole.
Among the 75 patients who completed the study, 13% of placebo recipients, 36% of 100-ug recipients, and 32% of 200-g recipients had conversion of cerebrospinal fluid fungal cultures from positive to negative at 2 weeks.
However, the researchers concede that the study population "was too small to demonstrate a statistically significant difference in...clearance of C. neoformans from cerebrospinal fluid at 2 weeks."
By week 10, culture conversion and survival rates were similar in the 3 groups. There was a trend toward better combined mycological-clinical outcome in the 2 treatment groups compared to the placebo group. Treatment with interferon was apparently well tolerated and had no impact on CD4 cell counts or HIV load.
Altogether, the researchers conclude that "recombinant interferon-gamma 1b may induce more-rapid early sterilization of cerebrospinal fluid among patients with HIV-associated cryptococcal meningitis and may result in better combined mycological and clinical outcomes."
J Infect Dis 2004;189:2185-2191.


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